Provider First Line Business Practice Location Address:
138 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-667-2850
Provider Business Practice Location Address Fax Number:
805-652-0708
Provider Enumeration Date:
07/22/2006