Provider First Line Business Practice Location Address:
2100 OTIS DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-5786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-265-2550
Provider Business Practice Location Address Fax Number:
510-220-0100
Provider Enumeration Date:
02/22/2006