Provider First Line Business Practice Location Address:
82 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-724-6764
Provider Business Practice Location Address Fax Number:
831-722-2316
Provider Enumeration Date:
07/08/2011