Provider First Line Business Practice Location Address:
2511 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-451-1337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2017