Provider First Line Business Practice Location Address:
CALIFORNIA MENS COLONY
Provider Second Line Business Practice Location Address:
HWY 1
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:
93409-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-7911
Provider Business Practice Location Address Fax Number:
805-547-7583
Provider Enumeration Date:
10/01/2007