Provider First Line Business Practice Location Address:
3974 VIA LUCERO APT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93110-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-409-8119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2025