Provider First Line Business Practice Location Address:
PO BOX 72
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93014-0072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-577-5006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2026