Provider First Line Business Practice Location Address:
1941 JOHNSON AVE STE 101
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:
93401-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-782-8844
Provider Business Practice Location Address Fax Number:
805-782-8859
Provider Enumeration Date:
03/27/2006