Provider First Line Business Practice Location Address:
6470 LEWIS AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-440-4776
Provider Business Practice Location Address Fax Number:
805-925-3041
Provider Enumeration Date:
12/01/2006