Provider First Line Business Practice Location Address:
670 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-826-8633
Provider Business Practice Location Address Fax Number:
707-826-8628
Provider Enumeration Date:
09/09/2016