Provider First Line Business Practice Location Address:
2181 JOHNSON AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-781-4243
Provider Business Practice Location Address Fax Number:
805-781-5541
Provider Enumeration Date:
11/21/2007