Provider First Line Business Practice Location Address:
145 BOYNTON PRAIRIE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-7743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007