Provider First Line Business Practice Location Address:
1816 1/2 WALNUT 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:
94501-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-717-0222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008