Provider First Line Business Practice Location Address:
2042 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:
94501-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-523-1995
Provider Business Practice Location Address Fax Number:
510-523-6155
Provider Enumeration Date:
05/23/2005