Provider First Line Business Practice Location Address:
1551 BISHOP ST
Provider Second Line Business Practice Location Address:
STE B210
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:
805-543-7788
Provider Business Practice Location Address Fax Number:
805-543-7828
Provider Enumeration Date:
08/31/2006