Provider First Line Business Practice Location Address:
2049 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-4296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-521-0588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2005