Provider First Line Business Practice Location Address:
4677 VALLEY WEST BLVD.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-5244
Provider Business Practice Location Address Fax Number:
707-822-5442
Provider Enumeration Date:
06/27/2012