Provider First Line Business Practice Location Address:
4779 VALLEY EAST BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-826-7870
Provider Business Practice Location Address Fax Number:
707-826-7869
Provider Enumeration Date:
10/13/2006