Provider First Line Business Practice Location Address:
1165 S DORA ST
Provider Second Line Business Practice Location Address:
SUITE G 2
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-8325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-5535
Provider Business Practice Location Address Fax Number:
707-463-0591
Provider Enumeration Date:
07/09/2006