Provider First Line Business Practice Location Address:
202 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-1589
Provider Business Practice Location Address Fax Number:
805-525-3245
Provider Enumeration Date:
05/23/2007