Provider First Line Business Practice Location Address:
911 CENTER ST
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:
95060-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-460-7162
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2023