Provider First Line Business Practice Location Address: 
1976 CLIFF DR
    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: 
93109-1504
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-564-6599
    Provider Business Practice Location Address Fax Number: 
805-899-4628
    Provider Enumeration Date: 
03/22/2023