Provider First Line Business Practice Location Address:
592 PALM AVE APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-660-3595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2006