Provider First Line Business Practice Location Address:
2648 STATE ST APT 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105-3585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-204-8777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008