Provider First Line Business Practice Location Address:
248 HOSPITAL DR STE B
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:
95482-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-5250
Provider Business Practice Location Address Fax Number:
707-462-1634
Provider Enumeration Date:
04/10/2019