Provider First Line Business Practice Location Address:
3100 SUMMIT STREET
Provider Second Line Business Practice Location Address:
SUMMIT CAMPUS PROVIDENCE PAVILLION
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-296-7156
Provider Business Practice Location Address Fax Number:
925-296-7174
Provider Enumeration Date:
08/18/2008