Provider First Line Business Practice Location Address:
1165 S DORA ST STE B1
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:
95482-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-0581
Provider Business Practice Location Address Fax Number:
707-463-0814
Provider Enumeration Date:
06/27/2006