Provider First Line Business Practice Location Address:
1150 GROVE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-709-7883
Provider Business Practice Location Address Fax Number:
805-473-0128
Provider Enumeration Date:
04/09/2009