Provider First Line Business Practice Location Address:
4560 HORTON ST
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:
94608-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-923-3526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2012