Provider First Line Business Practice Location Address:
631 W ORTEGA ST APT F
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:
93101-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-739-6858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2020