Provider First Line Business Practice Location Address:
260 HOSPITAL DR STE 207
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:
95482-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-7627
Provider Business Practice Location Address Fax Number:
707-463-7420
Provider Enumeration Date:
08/26/2025