Provider First Line Business Practice Location Address:
3505 BROADWAY
Provider Second Line Business Practice Location Address:
7TH FLOOR, GENETICS DEPT.
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-752-6396
Provider Business Practice Location Address Fax Number:
510-752-6754
Provider Enumeration Date:
11/21/2006