Provider First Line Business Practice Location Address:
4725 9TH ST SPC 15
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:
93013-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-570-8827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2023