Provider First Line Business Practice Location Address:
1250 PEACH ST
Provider Second Line Business Practice Location Address:
SUITE D
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:
93401-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-0330
Provider Business Practice Location Address Fax Number:
805-541-6809
Provider Enumeration Date:
12/06/2005