Provider First Line Business Practice Location Address:
1375 CHANEY 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:
93013-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-450-2794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2017