Provider First Line Business Practice Location Address:
1315 N STATE 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:
95482-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-5156
Provider Business Practice Location Address Fax Number:
707-468-1277
Provider Enumeration Date:
09/16/2014