Provider First Line Business Practice Location Address:
1276 JOHNSON AVE
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:
93408-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-781-5300
Provider Business Practice Location Address Fax Number:
805-781-1231
Provider Enumeration Date:
07/10/2008