Provider First Line Business Practice Location Address:
624 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-442-5739
Provider Business Practice Location Address Fax Number:
707-442-9013
Provider Enumeration Date:
10/05/2007