Provider First Line Business Practice Location Address:
1494 MILL ST
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:
93401-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-542-0954
Provider Business Practice Location Address Fax Number:
805-544-9273
Provider Enumeration Date:
01/29/2007