Provider First Line Business Practice Location Address: 
331 MAIN ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SALINAS
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93901-2705
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
831-424-8053
    Provider Business Practice Location Address Fax Number: 
831-424-4707
    Provider Enumeration Date: 
05/10/2013