Provider First Line Business Practice Location Address:
3862 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:
94611-5353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-499-7947
Provider Business Practice Location Address Fax Number:
510-868-1946
Provider Enumeration Date:
03/13/2007