Provider First Line Business Practice Location Address:
1598 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LEANDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94577-4465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-545-4588
Provider Business Practice Location Address Fax Number:
510-545-4675
Provider Enumeration Date:
04/30/2015