Provider First Line Business Practice Location Address:
10805 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-466-9254
Provider Business Practice Location Address Fax Number:
805-466-6007
Provider Enumeration Date:
10/10/2005