Provider First Line Business Practice Location Address:
823 APPLE 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:
94603-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-978-6213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007