Provider First Line Business Practice Location Address:
46 N ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93001-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-643-4048
Provider Business Practice Location Address Fax Number:
805-643-9207
Provider Enumeration Date:
12/18/2006