Provider First Line Business Practice Location Address:
5809 CASITAS PASS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-3090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-566-3741
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2026