Provider First Line Business Practice Location Address:
550 WATER ST
Provider Second Line Business Practice Location Address:
BLDG H
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-423-4363
Provider Business Practice Location Address Fax Number:
831-423-0824
Provider Enumeration Date:
01/22/2007