Provider First Line Business Practice Location Address:
1555 SOQUEL DR
Provider Second Line Business Practice Location Address:
ATTN: MEDICAL CREDENTIALLING DEPARTMENT
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95065-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-462-7509
Provider Business Practice Location Address Fax Number:
415-591-2417
Provider Enumeration Date:
02/15/2006