Provider First Line Business Practice Location Address:
260 INTERNATIONAL CIRCLE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE, HEALTHY LIVING CENTER, BLDG 1 NORTH
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-972-6248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2010