Provider First Line Business Practice Location Address:
147 RIVER STREET SOUTH
Provider Second Line Business Practice Location Address:
STE 211
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-423-1433
Provider Business Practice Location Address Fax Number:
831-423-6194
Provider Enumeration Date:
08/30/2006