Provider First Line Business Practice Location Address:
1204 LINCOLN AVE STE B
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:
94501-7436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-769-8535
Provider Business Practice Location Address Fax Number:
510-865-3403
Provider Enumeration Date:
04/11/2008