Provider First Line Business Practice Location Address:
5858 HORTON ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-654-4554
Provider Business Practice Location Address Fax Number:
510-654-4594
Provider Enumeration Date:
06/21/2005