Provider First Line Business Practice Location Address: 
2220 E GONZALES RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OXNARD
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93036-3707
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-981-5115
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/07/2023