Provider First Line Business Practice Location Address:
1335 A PARK AVENUE
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:
510-522-6053
Provider Business Practice Location Address Fax Number:
510-522-6061
Provider Enumeration Date:
12/27/2006