Provider First Line Business Practice Location Address:
803 YALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-5505
Provider Business Practice Location Address Fax Number:
805-525-9515
Provider Enumeration Date:
08/25/2006