Provider First Line Business Practice Location Address:
108 PORTAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93022-9722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-649-2727
Provider Business Practice Location Address Fax Number:
805-649-2018
Provider Enumeration Date:
01/22/2007