Provider First Line Business Practice Location Address:
66 OCEAN VIEW AVE APT 29
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:
93103-2983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-680-0184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2025