Provider First Line Business Practice Location Address:
98 S KELLOGG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93117-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-698-3862
Provider Business Practice Location Address Fax Number:
805-965-3797
Provider Enumeration Date:
12/01/2006