Provider First Line Business Practice Location Address:
101 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-502-9359
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2021