Provider First Line Business Practice Location Address:
4810 FOOTHILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-684-4107
Provider Business Practice Location Address Fax Number:
805-566-5952
Provider Enumeration Date:
04/29/2010