Provider First Line Business Practice Location Address:
248 W HARVARD BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-1573
Provider Business Practice Location Address Fax Number:
805-525-2676
Provider Enumeration Date:
07/16/2012