Provider First Line Business Practice Location Address:
1000 SANFORD RANCH RD
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:
95482-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-9331
Provider Business Practice Location Address Fax Number:
707-468-9007
Provider Enumeration Date:
05/07/2007