Provider First Line Business Practice Location Address:
1 GRAND AVE
Provider Second Line Business Practice Location Address:
CAL POLY STUDENT HEALTH SERVICES
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:
93407-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-756-1211
Provider Business Practice Location Address Fax Number:
805-756-5286
Provider Enumeration Date:
02/20/2007