Provider First Line Business Practice Location Address:
645 S BASCOM AVE
Provider Second Line Business Practice Location Address:
COMMUNITY HEALTH-1ST FLOOR
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-885-4214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006