Provider First Line Business Practice Location Address:
1118 WOOD 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:
94607-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-627-0326
Provider Business Practice Location Address Fax Number:
323-627-0326
Provider Enumeration Date:
01/11/2010