Provider First Line Business Practice Location Address:
747 52ND STREET
Provider Second Line Business Practice Location Address:
PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3058
Provider Business Practice Location Address Fax Number:
510-450-5813
Provider Enumeration Date:
07/17/2006