Provider First Line Business Practice Location Address:
4138 DYER ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94587-3975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-487-4800
Provider Business Practice Location Address Fax Number:
510-487-4802
Provider Enumeration Date:
11/23/2005