Provider First Line Business Practice Location Address:
368 28TH STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-7382
Provider Business Practice Location Address Fax Number:
510-465-7465
Provider Enumeration Date:
10/16/2006