Provider First Line Business Practice Location Address:
770 10TH ST
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:
95521-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-826-8610
Provider Business Practice Location Address Fax Number:
707-826-8623
Provider Enumeration Date:
06/02/2010