Provider First Line Business Practice Location Address:
1 MAIN ST
Provider Second Line Business Practice Location Address:
SAN QUENTIN STATE PRISION
Provider Business Practice Location Address City Name:
SAN QUENTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94964-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-454-1460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006