Provider First Line Business Practice Location Address:
1941 JOHNSON AVE STE 204
Provider Second Line Business Practice Location Address:
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:
93401-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-4347
Provider Business Practice Location Address Fax Number:
805-543-2083
Provider Enumeration Date:
07/25/2006