Provider First Line Business Practice Location Address:
401 QUARRY ROAD
Provider Second Line Business Practice Location Address:
STANFORD MEDICAL CENTER, DEPT PSYCHIATRY
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94305-5722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-723-6308
Provider Business Practice Location Address Fax Number:
650-723-9807
Provider Enumeration Date:
04/15/2010