Provider First Line Business Practice Location Address:
1235 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:
510-352-2425
Provider Business Practice Location Address Fax Number:
510-352-6273
Provider Enumeration Date:
04/05/2006