Provider First Line Business Practice Location Address:
431 30TH ST
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:
94609-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-898-6546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2007