Provider First Line Business Practice Location Address:
216 WEST PERKINS ST
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-8520
Provider Business Practice Location Address Fax Number:
707-468-4349
Provider Enumeration Date:
03/05/2007