Provider First Line Business Practice Location Address:
1553 WEBSTER 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:
94501-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-3066
Provider Business Practice Location Address Fax Number:
510-522-3669
Provider Enumeration Date:
09/30/2006