Provider First Line Business Practice Location Address:
220 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-6621
Provider Business Practice Location Address Fax Number:
805-933-9182
Provider Enumeration Date:
09/16/2006