Provider First Line Business Practice Location Address:
930 W HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-269-2851
Provider Business Practice Location Address Fax Number:
707-269-7558
Provider Enumeration Date:
08/25/2026