Provider First Line Business Practice Location Address:
1211 MARICOPA HWY
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
OJAI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93023-3162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-662-0023
Provider Business Practice Location Address Fax Number:
805-640-0776
Provider Enumeration Date:
12/14/2006