Provider First Line Business Practice Location Address: 
4570 CALLE REAL
    Provider Second Line Business Practice Location Address: 
CASA DEL MURAL
    Provider Business Practice Location Address City Name: 
SANTA BARBARA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
93110-1306
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-708-9292
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/20/2006