Provider First Line Business Practice Location Address:
4000 HARLAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-868-9175
Provider Business Practice Location Address Fax Number:
855-380-4834
Provider Enumeration Date:
11/18/2013