Provider First Line Business Practice Location Address:
1510 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93445-9301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-473-7137
Provider Business Practice Location Address Fax Number:
805-473-7118
Provider Enumeration Date:
10/13/2006