Provider First Line Business Practice Location Address:
1930 MONTEREY STREET
Provider Second Line Business Practice Location Address:
CONFERENCE RM 3 & 4
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:
93401-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-252-1770
Provider Business Practice Location Address Fax Number:
559-252-1781
Provider Enumeration Date:
04/06/2012