Provider First Line Business Practice Location Address:
2217 CENTRAL 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:
94501-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-7010
Provider Business Practice Location Address Fax Number:
510-522-2654
Provider Enumeration Date:
04/13/2007