Provider First Line Business Practice Location Address:
133 JUANA MARIA AVE
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:
93103-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-597-1490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2026