Provider First Line Business Practice Location Address:
5900 HOLLIS STREET #K
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-922-1614
Provider Business Practice Location Address Fax Number:
510-922-8564
Provider Enumeration Date:
10/03/2007