Provider First Line Business Practice Location Address:
216 N 6TH ST UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
820-777-9740
Provider Business Practice Location Address Fax Number:
820-777-9740
Provider Enumeration Date:
03/31/2025