Provider First Line Business Practice Location Address:
1998 SANTA BARBARA AVE STE 200
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:
93401-4488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-540-6500
Provider Business Practice Location Address Fax Number:
805-540-6501
Provider Enumeration Date:
08/20/2026