Provider First Line Business Practice Location Address:
465 34TH 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:
94609-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-595-3533
Provider Business Practice Location Address Fax Number:
510-549-0736
Provider Enumeration Date:
12/19/2006