Provider First Line Business Practice Location Address:
1433 11TH ST STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-633-8189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2019