Provider First Line Business Practice Location Address:
1310 EAST MAIN STREET
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:
93060-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-8159
Provider Business Practice Location Address Fax Number:
805-525-8247
Provider Enumeration Date:
02/04/2009