Provider First Line Business Practice Location Address:
1912 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:
94501-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-750-8810
Provider Business Practice Location Address Fax Number:
925-484-1075
Provider Enumeration Date:
01/14/2008