Provider First Line Business Practice Location Address:
8500 SAN GABRIEL RD
Provider Second Line Business Practice Location Address:
BOX A
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-461-6126
Provider Business Practice Location Address Fax Number:
805-461-5138
Provider Enumeration Date:
10/13/2006