Provider First Line Business Practice Location Address:
480 4TH 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:
94607-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-577-1900
Provider Business Practice Location Address Fax Number:
510-577-5618
Provider Enumeration Date:
02/26/2008