Provider First Line Business Practice Location Address:
1941 JOHNSON AVE
Provider Second Line Business Practice Location Address:
SUITE #202
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:
93401-4140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-548-0033
Provider Business Practice Location Address Fax Number:
805-548-0034
Provider Enumeration Date:
08/05/2006