Provider First Line Business Practice Location Address:
3800 JANES RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-1385
Provider Business Practice Location Address Fax Number:
707-825-8203
Provider Enumeration Date:
12/11/2013