Provider First Line Business Practice Location Address:
474 SCENIC DR APT C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-680-0905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2021