Provider First Line Business Practice Location Address:
6121 HOLLIS ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-2077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-601-7979
Provider Business Practice Location Address Fax Number:
510-420-3484
Provider Enumeration Date:
05/19/2006