Provider First Line Business Practice Location Address:
1533 COURT ST
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:
94501-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-764-8188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2014