Provider First Line Business Practice Location Address:
260 HOSPITAL DR.
Provider Second Line Business Practice Location Address:
SUITE #209
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-8000
Provider Business Practice Location Address Fax Number:
707-462-1111
Provider Enumeration Date:
10/12/2007