Provider First Line Business Practice Location Address:
649 VERDE MAR UNIT D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-5742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-450-3891
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2019