Provider First Line Business Practice Location Address:
1215 DE LA VINA STREET
Provider Second Line Business Practice Location Address:
SUITE D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-966-5165
Provider Business Practice Location Address Fax Number:
805-957-9612
Provider Enumeration Date:
08/01/2006