Provider First Line Business Practice Location Address:
101 W CHURCH ST
Provider Second Line Business Practice Location Address:
STE #3
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-2230
Provider Business Practice Location Address Fax Number:
253-559-6158
Provider Enumeration Date:
05/15/2007