Provider First Line Business Practice Location Address:
1475 CLAY 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:
94612-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-836-4225
Provider Business Practice Location Address Fax Number:
510-836-1449
Provider Enumeration Date:
01/08/2007