Provider First Line Business Practice Location Address:
3923 PIEDMONT AVE
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:
94611-4546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-287-6191
Provider Business Practice Location Address Fax Number:
510-601-7110
Provider Enumeration Date:
10/27/2006