Provider First Line Business Practice Location Address:
1833 PORTOLA RD UNITS K & L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-6435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-981-2500
Provider Business Practice Location Address Fax Number:
805-981-8447
Provider Enumeration Date:
08/31/2006