Provider First Line Business Practice Location Address:
1145 E CLARK AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCUTT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93455-5151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-270-5020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2023