Provider First Line Business Practice Location Address:
22 W MICHELTORENA ST STE 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:
93101-6524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-674-9984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2021