Provider First Line Business Practice Location Address:
281 13TH ST
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:
94612-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-8707
Provider Business Practice Location Address Fax Number:
510-465-8660
Provider Enumeration Date:
07/05/2006