Provider First Line Business Practice Location Address:
1628 STATE ST APT 8
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:
93101-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-705-7304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2024