Provider First Line Business Practice Location Address:
1129 PACIFIC 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:
93401-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-8731
Provider Business Practice Location Address Fax Number:
805-541-8047
Provider Enumeration Date:
10/17/2005