Provider First Line Business Practice Location Address:
5955 BALM RIDGE WAY
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:
93401-8024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-2581
Provider Business Practice Location Address Fax Number:
805-547-1226
Provider Enumeration Date:
04/01/2009