Provider First Line Business Practice Location Address:
604 HARRIS STREET
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:
707-443-8064
Provider Business Practice Location Address Fax Number:
707-443-0344
Provider Enumeration Date:
06/16/2008