Provider First Line Business Practice Location Address:
707 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:
95482-5335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-8707
Provider Business Practice Location Address Fax Number:
775-640-8755
Provider Enumeration Date:
04/28/2006