Provider First Line Business Practice Location Address:
313 SOQUEL AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95062-2347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-469-3200
Provider Business Practice Location Address Fax Number:
831-477-1575
Provider Enumeration Date:
05/01/2007