Provider First Line Business Practice Location Address:
1432 PARK 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:
94501-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-769-2020
Provider Business Practice Location Address Fax Number:
510-769-7912
Provider Enumeration Date:
07/25/2007