Provider First Line Business Practice Location Address:
5665 COLLEGE AVE
Provider Second Line Business Practice Location Address:
STE. 240D
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94618-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-457-6601
Provider Business Practice Location Address Fax Number:
510-380-6687
Provider Enumeration Date:
09/22/2008