Provider First Line Business Practice Location Address:
1901 CLEVELAND AVENUE, # B
Provider Second Line Business Practice Location Address:
SANTA ROSA TREATMENT PROGRAM
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-566-0170
Provider Business Practice Location Address Fax Number:
707-568-5445
Provider Enumeration Date:
05/28/2007