Provider First Line Business Practice Location Address:
332 19TH 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:
94612-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-384-8653
Provider Business Practice Location Address Fax Number:
510-588-5598
Provider Enumeration Date:
09/08/2010