Provider First Line Business Practice Location Address:
1240 POWELL ST STE 2C
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:
94608-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-287-8922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2007