Provider First Line Business Practice Location Address:
1279 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-4813
Provider Business Practice Location Address Fax Number:
707-465-1442
Provider Enumeration Date:
09/23/2014