Provider First Line Business Practice Location Address:
100 CAMPUS CTR
Provider Second Line Business Practice Location Address:
ATHLETIC TRAINING ROOM, BLDG 90
Provider Business Practice Location Address City Name:
SEASIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93955-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-582-3010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006