Provider First Line Business Practice Location Address:
449 CENTRAL AVE APT B
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:
94501-3671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-823-5060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2023