Provider First Line Business Practice Location Address:
622 E SANTA PAULA 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:
93060-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
85-873-3324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2023