Provider First Line Business Practice Location Address:
CALIFORNIA MENS COLONY STATE PRISON
Provider Second Line Business Practice Location Address:
HWY 1
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:
93409-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-7900
Provider Business Practice Location Address Fax Number:
805-547-7543
Provider Enumeration Date:
05/01/2014