Provider First Line Business Practice Location Address:
1332 PARK ST
Provider Second Line Business Practice Location Address:
SUITE #202
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-523-3417
Provider Business Practice Location Address Fax Number:
510-521-1659
Provider Enumeration Date:
05/17/2006