Provider First Line Business Practice Location Address:
2059 CLINTON AVE STE 1
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:
94501-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-521-2568
Provider Business Practice Location Address Fax Number:
510-521-9610
Provider Enumeration Date:
03/29/2023