Provider First Line Business Practice Location Address:
845 N 10TH ST
Provider Second Line Business Practice Location Address:
STE #1
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-5762
Provider Business Practice Location Address Fax Number:
805-525-7277
Provider Enumeration Date:
03/02/2007