Provider First Line Business Practice Location Address:
1250 PEACH ST
Provider Second Line Business Practice Location Address:
STE A
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:
93401-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-596-0900
Provider Business Practice Location Address Fax Number:
805-596-0945
Provider Enumeration Date:
06/01/2005