Provider First Line Business Practice Location Address:
2203 SAN ANTONIO AVE
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:
94501-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-990-1920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2025