Provider First Line Business Practice Location Address:
1828 9TH ST
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:
94501-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-328-5943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2026