Provider First Line Business Practice Location Address:
717 MARSH 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:
93401-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-9885
Provider Business Practice Location Address Fax Number:
805-547-9986
Provider Enumeration Date:
06/15/2006