Provider First Line Business Practice Location Address:
641 SOUTH ORCHARD AVENUE
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:
707-467-2010
Provider Business Practice Location Address Fax Number:
833-895-1442
Provider Enumeration Date:
12/03/2024