Provider First Line Business Practice Location Address:
931 WALNUT AVE
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:
93013-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-560-1050
Provider Business Practice Location Address Fax Number:
805-560-1051
Provider Enumeration Date:
12/28/2006