Provider First Line Business Practice Location Address:
1333 JOHNSON AVE
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:
93401-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-242-3516
Provider Business Practice Location Address Fax Number:
805-439-4939
Provider Enumeration Date:
04/08/2013