Provider First Line Business Practice Location Address:
218 CHANNING WAY
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:
94502-6452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-3812
Provider Business Practice Location Address Fax Number:
510-903-1312
Provider Enumeration Date:
10/01/2008