Provider First Line Business Practice Location Address:
2662 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-443-4563
Provider Business Practice Location Address Fax Number:
707-443-2527
Provider Enumeration Date:
08/28/2008