Provider First Line Business Practice Location Address:
1429 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-6554
Provider Business Practice Location Address Fax Number:
510-521-6729
Provider Enumeration Date:
05/30/2007