Provider First Line Business Practice Location Address:
2856 SANTA BARBARA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS OLIVOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93441-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-413-2192
Provider Business Practice Location Address Fax Number:
805-697-0010
Provider Enumeration Date:
09/01/2026