Provider First Line Business Practice Location Address:
401 W MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-595-4755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2011