Provider First Line Business Practice Location Address:
2447 TELEGRAPH AVE
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:
94612-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-500-5224
Provider Business Practice Location Address Fax Number:
510-920-0961
Provider Enumeration Date:
08/22/2025