Provider First Line Business Practice Location Address:
5905 CAPISTRANO AVE
Provider Second Line Business Practice Location Address:
#C
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-461-7144
Provider Business Practice Location Address Fax Number:
805-461-7141
Provider Enumeration Date:
06/30/2008