Provider First Line Business Practice Location Address:
1240 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-466-9029
Provider Business Practice Location Address Fax Number:
805-461-4828
Provider Enumeration Date:
12/07/2006