Provider First Line Business Practice Location Address:
1239 HARRISON ST
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:
94577-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-351-5711
Provider Business Practice Location Address Fax Number:
510-351-5751
Provider Enumeration Date:
03/26/2007