Provider First Line Business Practice Location Address:
850 LINDEN AVE
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:
93013-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-684-4124
Provider Business Practice Location Address Fax Number:
805-684-2362
Provider Enumeration Date:
10/26/2010