Provider First Line Business Practice Location Address:
809 DE LA VINA ST
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:
93101-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-347-3338
Provider Business Practice Location Address Fax Number:
800-401-4105
Provider Enumeration Date:
12/21/2023