Provider First Line Business Practice Location Address:
2149 CENTRAL AVE
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:
94501-2894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-769-0477
Provider Business Practice Location Address Fax Number:
510-769-9417
Provider Enumeration Date:
01/17/2008