Provider First Line Business Practice Location Address:
825 N 10TH 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:
93060-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-647-0880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2006