Provider First Line Business Practice Location Address:
1402 PARK ST STE G
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:
94501-4562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-900-5123
Provider Business Practice Location Address Fax Number:
888-974-4218
Provider Enumeration Date:
05/01/2013