Provider First Line Business Practice Location Address:
1611 STANTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-769-6627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007