Provider First Line Business Practice Location Address: 
5025 8TH ST
    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: 
93013-2018
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-566-1358
    Provider Business Practice Location Address Fax Number: 
805-566-2148
    Provider Enumeration Date: 
02/11/2007