Provider First Line Business Practice Location Address:
684 HIGUERA ST
Provider Second Line Business Practice Location Address:
SUITE C
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:
93401-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-709-7793
Provider Business Practice Location Address Fax Number:
805-773-0946
Provider Enumeration Date:
06/19/2008