Provider First Line Business Practice Location Address: 
2400 BATH ST STE 202
    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: 
93105
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-682-3721
    Provider Business Practice Location Address Fax Number: 
805-682-3772
    Provider Enumeration Date: 
06/21/2012