Provider First Line Business Practice Location Address:
3124 KINGSLAND AVE
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:
94619-3370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-436-4647
Provider Business Practice Location Address Fax Number:
510-436-4647
Provider Enumeration Date:
05/29/2007