Provider First Line Business Practice Location Address:
280 W MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
RM #1118
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-808-4640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2013