Provider First Line Business Practice Location Address:
6116 MERCED AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-339-1250
Provider Business Practice Location Address Fax Number:
510-339-1021
Provider Enumeration Date:
09/20/2006