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1861989865
KEITH VIDRA
UKIAH, CA
NPI
1861989865
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Enumeration Date
2018-04-16
Last Update Date
2018-04-16
Business Address
KEITH VIDRA
140 GIBSON ST
UKIAH, CA 95482-3941
Phone number: 707-468-5536
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Mailing Address
KEITH VIDRA
PO BOX 2077
UKIAH, CA 95482-2077
Phone number: 707-467-2010
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