Provider First Line Business Practice Location Address:
1610 DE LA VINA ST APT 2
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:
93101-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-886-8104
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2019