Provider First Line Business Practice Location Address:
2385 CARPENTER CANYON RD
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:
93401-8935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-6245
Provider Business Practice Location Address Fax Number:
805-468-3111
Provider Enumeration Date:
12/21/2006