Provider First Line Business Practice Location Address:
1413 PARK 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:
94501-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-865-8265
Provider Business Practice Location Address Fax Number:
510-865-8264
Provider Enumeration Date:
11/13/2015