Provider First Line Business Practice Location Address: 
317 W PUEBLO ST
    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: 
93105-4355
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
805-681-1761
    Provider Business Practice Location Address Fax Number: 
805-681-1768
    Provider Enumeration Date: 
08/24/2006