Provider First Line Business Practice Location Address:
2120 CIENAGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93445-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-994-2103
Provider Business Practice Location Address Fax Number:
805-994-2195
Provider Enumeration Date:
04/11/2025