Provider First Line Business Practice Location Address:
1020 W PERKINS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-943-6303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2016