Provider First Line Business Practice Location Address:
149 S 1ST ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
ORCUTT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93455-5260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-938-3151
Provider Business Practice Location Address Fax Number:
805-938-3157
Provider Enumeration Date:
01/22/2008