Provider First Line Business Practice Location Address:
172 WASHINGTON AVE STE A
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:
95482-6319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-4136
Provider Business Practice Location Address Fax Number:
310-791-1087
Provider Enumeration Date:
09/11/2024