Provider First Line Business Practice Location Address:
1422 MONTEREY ST
Provider Second Line Business Practice Location Address:
A201
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:
93401-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-781-9155
Provider Business Practice Location Address Fax Number:
805-781-0141
Provider Enumeration Date:
07/12/2005