Provider First Line Business Practice Location Address:
215 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-740-8800
Provider Business Practice Location Address Fax Number:
830-740-8812
Provider Enumeration Date:
08/18/2025