Provider First Line Business Practice Location Address:
680 S ORCHARD AVE
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:
95482-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-1984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2010