Provider First Line Business Practice Location Address:
784 HIGH STREET
Provider Second Line Business Practice Location Address:
C/O TRANSITIONS - MHA
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:
805-541-0107
Provider Business Practice Location Address Fax Number:
805-544-0741
Provider Enumeration Date:
08/10/2010