Provider First Line Business Practice Location Address:
200 S. WELLS RD.
Provider Second Line Business Practice Location Address:
CLINICAS DEL CAMINO REAL, INCORPORATED SUTIE 200
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-217-4484
Provider Business Practice Location Address Fax Number:
805-659-9959
Provider Enumeration Date:
09/17/2010