Provider First Line Business Practice Location Address:
922 STATE ST STE A2-5
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:
93101-6795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-452-6754
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2018