Provider First Line Business Practice Location Address:
2180 JOHNSON AVE
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:
93401-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-781-4997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2010