Provider First Line Business Practice Location Address:
1190 MARSH ST
Provider Second Line Business Practice Location Address:
SUITE C
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:
93401-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-781-9530
Provider Business Practice Location Address Fax Number:
805-784-0486
Provider Enumeration Date:
12/14/2006