Provider First Line Business Practice Location Address:
680 S 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:
95482-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-6850
Provider Business Practice Location Address Fax Number:
707-462-0348
Provider Enumeration Date:
04/11/2011