Provider First Line Business Practice Location Address:
1464 SPEAR AVE
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:
95521-4882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-4721
Provider Business Practice Location Address Fax Number:
707-822-7054
Provider Enumeration Date:
05/29/2024