Provider First Line Business Practice Location Address:
1 EL VEDADO LN APT 20
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:
93105-3575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-670-8852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2025