Provider First Line Business Practice Location Address:
1118 S SEAWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93001-3849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-643-8000
Provider Business Practice Location Address Fax Number:
805-643-6577
Provider Enumeration Date:
09/24/2006