Provider First Line Business Practice Location Address:
1 GRAND AVE
Provider Second Line Business Practice Location Address:
CP ATHLETICS
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:
805-756-5491
Provider Business Practice Location Address Fax Number:
805-756-7058
Provider Enumeration Date:
05/02/2006