Provider First Line Business Practice Location Address:
1911 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:
93401-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-5353
Provider Business Practice Location Address Fax Number:
805-543-5708
Provider Enumeration Date:
03/09/2007