Provider First Line Business Practice Location Address:
785 18TH 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:
95521-5683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-2481
Provider Business Practice Location Address Fax Number:
707-822-3656
Provider Enumeration Date:
07/05/2016