Provider First Line Business Practice Location Address:
730 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-363-9260
Provider Business Practice Location Address Fax Number:
707-441-4679
Provider Enumeration Date:
09/15/2009