Provider First Line Business Practice Location Address:
2354 POWELL ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-652-7445
Provider Business Practice Location Address Fax Number:
510-652-9288
Provider Enumeration Date:
02/20/2013