Provider First Line Business Practice Location Address:
960 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-747-1740
Provider Business Practice Location Address Fax Number:
510-747-1924
Provider Enumeration Date:
12/05/2005