Provider First Line Business Practice Location Address:
1240 S LOOP RD
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:
94502-7084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-747-4555
Provider Business Practice Location Address Fax Number:
510-747-4502
Provider Enumeration Date:
01/23/2007