Provider First Line Business Practice Location Address:
1515 WEBSTER STREET
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:
94612-3355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-596-8901
Provider Business Practice Location Address Fax Number:
510-596-8905
Provider Enumeration Date:
01/27/2010