Provider First Line Business Practice Location Address:
747 52ND STREET, ROOM 201
Provider Second Line Business Practice Location Address:
PEDIATRIC MULTISPECIALTY MEDICAL GROUP
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-8339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2012