Provider First Line Business Practice Location Address:
751 S BASCOM AVE
Provider Second Line Business Practice Location Address:
INTERNAL MED-MAIN JAIL
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-957-5360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006