Provider First Line Business Practice Location Address:
400 E CLARK
Provider Second Line Business Practice Location Address:
#D
Provider Business Practice Location Address City Name:
ORCUTT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-452-2496
Provider Business Practice Location Address Fax Number:
805-344-3565
Provider Enumeration Date:
09/27/2007