Provider First Line Business Practice Location Address:
310 N 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-320-0379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2011