Provider First Line Business Practice Location Address:
1761 BROADWAY SUITE 100
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE VALLEJO MEDICAL CENTER DEPT OF PSYCIA
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94589-2485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-645-2700
Provider Business Practice Location Address Fax Number:
707-645-2181
Provider Enumeration Date:
12/18/2006