Provider First Line Business Practice Location Address:
1412 GRAND ST
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:
94501-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-337-0283
Provider Business Practice Location Address Fax Number:
510-337-0521
Provider Enumeration Date:
02/28/2007