Provider First Line Business Practice Location Address:
104 S PATTERSON AVE APT 101
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:
93111-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-639-9146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2017