Provider First Line Business Practice Location Address:
2242 SANTA CLARA 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:
94501-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-523-1862
Provider Business Practice Location Address Fax Number:
510-521-1595
Provider Enumeration Date:
04/24/2007