Provider First Line Business Practice Location Address:
7375 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-4697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-466-5247
Provider Business Practice Location Address Fax Number:
805-466-5246
Provider Enumeration Date:
10/20/2006