Provider First Line Business Practice Location Address:
10333 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF STATE HOSPITALS - ATASCADERO
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93423-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-651-9475
Provider Business Practice Location Address Fax Number:
916-651-8908
Provider Enumeration Date:
08/15/2005