Provider First Line Business Practice Location Address:
1545 MORSE AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-5171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-676-1800
Provider Business Practice Location Address Fax Number:
805-676-1818
Provider Enumeration Date:
07/18/2006