Provider First Line Business Practice Location Address:
747 52 STREET
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:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3336
Provider Business Practice Location Address Fax Number:
510-601-3957
Provider Enumeration Date:
06/15/2006