Provider First Line Business Practice Location Address:
1733 J ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-504-7440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2025