Provider First Line Business Practice Location Address:
3798 JANES RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-633-6517
Provider Business Practice Location Address Fax Number:
707-633-6518
Provider Enumeration Date:
04/14/2014