Provider First Line Business Practice Location Address:
212 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-473-6605
Provider Business Practice Location Address Fax Number:
510-521-5891
Provider Enumeration Date:
07/21/2007