Provider First Line Business Practice Location Address:
287 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-832-1804
Provider Business Practice Location Address Fax Number:
510-891-9278
Provider Enumeration Date:
04/13/2007