Provider First Line Business Practice Location Address:
5980 HORTON ST STE 105
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:
94608-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-823-2646
Provider Business Practice Location Address Fax Number:
510-823-2648
Provider Enumeration Date:
08/31/2016