Provider First Line Business Practice Location Address:
260 HOSPITAL DR STE 204
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:
95482-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-467-4327
Provider Business Practice Location Address Fax Number:
707-463-2557
Provider Enumeration Date:
04/23/2019