Provider First Line Business Practice Location Address:
1101 S DORA 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:
95482-6341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-8787
Provider Business Practice Location Address Fax Number:
707-468-8725
Provider Enumeration Date:
09/20/2006