Provider First Line Business Practice Location Address:
165 E HIGH ST
Provider Second Line Business Practice Location Address:
SIUTE 101
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-529-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2007