Provider First Line Business Practice Location Address:
415 E MICHELTORENA ST APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-459-8512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2009