Provider First Line Business Practice Location Address:
4517 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-7710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-650-5929
Provider Business Practice Location Address Fax Number:
805-650-5947
Provider Enumeration Date:
10/19/2005