Provider First Line Business Practice Location Address:
19000 HOMESTEAD RD
Provider Second Line Business Practice Location Address:
CHILD AND ADOLESCENT PSYCHIATRY, BUILDING 2
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014-0712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-366-4468
Provider Business Practice Location Address Fax Number:
408-366-4480
Provider Enumeration Date:
11/13/2006