Provider First Line Business Practice Location Address:
1 GRAND AVE.
Provider Second Line Business Practice Location Address:
CAL POLY HEALTH SERVICES
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:
93407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-756-5280
Provider Business Practice Location Address Fax Number:
805-756-5280
Provider Enumeration Date:
11/01/2006