Provider First Line Business Practice Location Address:
1318 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:
93401-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-2300
Provider Business Practice Location Address Fax Number:
805-541-2301
Provider Enumeration Date:
07/12/2006