Provider First Line Business Practice Location Address:
1226 SOQUEL AVE STE A
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95062-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-423-2315
Provider Business Practice Location Address Fax Number:
831-423-2320
Provider Enumeration Date:
01/24/2007