Provider First Line Business Practice Location Address:
1644 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
MCKINLEYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-839-3068
Provider Business Practice Location Address Fax Number:
707-839-3827
Provider Enumeration Date:
10/02/2006