Provider First Line Business Practice Location Address:
388 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-4287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-4599
Provider Business Practice Location Address Fax Number:
510-465-3469
Provider Enumeration Date:
03/20/2007