Provider First Line Business Practice Location Address:
HIGHWAY 1 NORTH
Provider Second Line Business Practice Location Address:
CALIFORNIA MEN'S COLONY PRISON
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:
93409-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2012