Provider First Line Business Practice Location Address:
1 GRAND AVE
Provider Second Line Business Practice Location Address:
CAL POLY STATE UNIV.,PSYCHOLOGY & CHILD DEV. DEPARTMENT
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:
93407-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-756-6123
Provider Business Practice Location Address Fax Number:
805-756-1134
Provider Enumeration Date:
03/01/2007