Provider First Line Business Practice Location Address:
150 B SO. 6TH ST.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GROVER BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-5738
Provider Business Practice Location Address Fax Number:
805-481-6316
Provider Enumeration Date:
11/07/2006