Provider First Line Business Practice Location Address:
1998 SANTA BARBARA 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:
93401-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-548-2644
Provider Business Practice Location Address Fax Number:
805-540-6501
Provider Enumeration Date:
12/30/2015