Provider First Line Business Practice Location Address:
225 CLIFTON ST
Provider Second Line Business Practice Location Address:
APT 212
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94618-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-452-9946
Provider Business Practice Location Address Fax Number:
510-452-9946
Provider Enumeration Date:
02/21/2007