Provider First Line Business Practice Location Address:
2416A CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-316-5806
Provider Business Practice Location Address Fax Number:
510-903-5905
Provider Enumeration Date:
10/03/2006