Provider First Line Business Practice Location Address:
5425 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-3355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-461-3422
Provider Business Practice Location Address Fax Number:
805-461-3448
Provider Enumeration Date:
07/15/2006