Provider First Line Business Practice Location Address:
972 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-3001
Provider Business Practice Location Address Fax Number:
805-525-7468
Provider Enumeration Date:
01/12/2007