Provider First Line Business Practice Location Address:
1250 PEACH ST STE L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-544-1877
Provider Business Practice Location Address Fax Number:
805-544-9026
Provider Enumeration Date:
11/16/2006