Provider First Line Business Practice Location Address:
495 ELWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94610-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-207-8261
Provider Business Practice Location Address Fax Number:
510-336-6621
Provider Enumeration Date:
03/09/2011