Provider First Line Business Practice Location Address:
492 CLIFTON 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:
94618-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-273-9261
Provider Business Practice Location Address Fax Number:
510-653-8787
Provider Enumeration Date:
07/10/2006