Provider First Line Business Practice Location Address:
2017 CENTRAL AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-522-0878
Provider Business Practice Location Address Fax Number:
510-522-0894
Provider Enumeration Date:
08/15/2006