Provider First Line Business Practice Location Address:
430 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-2691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-844-0095
Provider Business Practice Location Address Fax Number:
510-844-0245
Provider Enumeration Date:
10/20/2006