Provider First Line Business Practice Location Address:
1429 HIGH 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:
94501-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-5097
Provider Business Practice Location Address Fax Number:
510-522-0815
Provider Enumeration Date:
10/26/2005