Provider First Line Business Practice Location Address:
940 UKIAH ST.
Provider Second Line Business Practice Location Address:
BOX 1129
Provider Business Practice Location Address City Name:
MENDOCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-937-4202
Provider Business Practice Location Address Fax Number:
707-937-6003
Provider Enumeration Date:
10/12/2006