Provider First Line Business Practice Location Address:
2719 ENCINAL AVE STE A-2
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:
94501-4784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-214-2591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2011