Provider First Line Business Practice Location Address:
1621 GRAND AVENUE
Provider Second Line Business Practice Location Address:
VILLA RIVIERA
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-568-5840
Provider Business Practice Location Address Fax Number:
805-568-5844
Provider Enumeration Date:
05/20/2009