Provider First Line Business Practice Location Address:
320 10TH 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:
94604-4071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-919-1819
Provider Business Practice Location Address Fax Number:
510-383-9803
Provider Enumeration Date:
08/22/2007