Provider First Line Business Practice Location Address:
1422 MONTEREY ST
Provider Second Line Business Practice Location Address:
SUITE C-102
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:
93401-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-5100
Provider Business Practice Location Address Fax Number:
805-543-5106
Provider Enumeration Date:
08/16/2006