Provider First Line Business Practice Location Address:
618 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-362-6951
Provider Business Practice Location Address Fax Number:
707-445-4666
Provider Enumeration Date:
08/01/2012