Provider First Line Business Practice Location Address:
1018 CASITAS PASS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-684-8367
Provider Business Practice Location Address Fax Number:
805-684-8848
Provider Enumeration Date:
06/23/2015