Provider First Line Business Practice Location Address:
628 CALIFORNIA BLVD STE F
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:
93401-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-540-5035
Provider Business Practice Location Address Fax Number:
805-540-5036
Provider Enumeration Date:
08/15/2005