Provider First Line Business Practice Location Address:
5461 FOOTHILL BLVD
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:
94601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-532-0918
Provider Business Practice Location Address Fax Number:
510-532-0956
Provider Enumeration Date:
11/17/2006