Provider First Line Business Practice Location Address:
3999 VIA LUCERO APT A22
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:
93110-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-215-5173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2025