Provider First Line Business Practice Location Address:
3855 BROAD STREET
Provider Second Line Business Practice Location Address:
STE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-545-8100
Provider Business Practice Location Address Fax Number:
805-545-8902
Provider Enumeration Date:
06/01/2005