Provider First Line Business Practice Location Address:
3060 E 9TH ST STE B
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:
94601-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-5500
Provider Business Practice Location Address Fax Number:
510-535-4225
Provider Enumeration Date:
11/28/2006