Provider First Line Business Practice Location Address:
5707 CHRISTIE AVE
Provider Second Line Business Practice Location Address:
POWELL STREET PLAZA
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-547-8301
Provider Business Practice Location Address Fax Number:
510-547-3739
Provider Enumeration Date:
01/17/2007