Provider First Line Business Practice Location Address:
940 9TH ST
Provider Second Line Business Practice Location Address:
OASIS
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-498-1123
Provider Business Practice Location Address Fax Number:
707-442-7774
Provider Enumeration Date:
06/08/2007