Provider First Line Business Practice Location Address:
19965 S MOUNTAIN RD
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:
93060-9564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-298-3631
Provider Business Practice Location Address Fax Number:
805-532-1454
Provider Enumeration Date:
12/12/2012