Provider First Line Business Practice Location Address:
3546 S HIGUERA ST
Provider Second Line Business Practice Location Address:
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:
93401-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-2626
Provider Business Practice Location Address Fax Number:
805-546-0885
Provider Enumeration Date:
05/05/2006