Provider First Line Business Practice Location Address:
873 1/2 PALM AVE
Provider Second Line Business Practice Location Address:
UNIT D
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-220-8293
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2023