Provider First Line Business Practice Location Address:
727 S. STATE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-467-5828
Provider Business Practice Location Address Fax Number:
707-463-7908
Provider Enumeration Date:
10/15/2007