Provider First Line Business Practice Location Address:
1122 E 21ST 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:
94606-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-406-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2014