Provider First Line Business Practice Location Address:
1000A & 1010C EMELINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-425-0112
Provider Business Practice Location Address Fax Number:
831-425-1847
Provider Enumeration Date:
03/14/2007