Provider First Line Business Practice Location Address:
1 MAIN ST
Provider Second Line Business Practice Location Address:
OHU - SAN QUENTIN STATE PRISON
Provider Business Practice Location Address City Name:
SAN QUENTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94964-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-721-3590
Provider Business Practice Location Address Fax Number:
415-721-3547
Provider Enumeration Date:
07/18/2006