Provider First Line Business Practice Location Address:
275 S ORCHARD AVE
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:
95482-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-3440
Provider Business Practice Location Address Fax Number:
707-463-3446
Provider Enumeration Date:
07/29/2014