Provider First Line Business Practice Location Address:
1330 LINCOLN AVE.
Provider Second Line Business Practice Location Address:
#201 COMMUNITY INSTITUTE FOR PSYCHOTHERAPY
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
99401-2141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-459-5999
Provider Business Practice Location Address Fax Number:
415-459-5602
Provider Enumeration Date:
04/03/2017