Provider First Line Business Practice Location Address:
2416-A CENTRAL AVE.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-284-6987
Provider Business Practice Location Address Fax Number:
888-297-6166
Provider Enumeration Date:
03/16/2007