Provider First Line Business Practice Location Address:
248 HOSPITAL DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-1659
Provider Business Practice Location Address Fax Number:
707-463-2195
Provider Enumeration Date:
08/21/2007