Provider First Line Business Practice Location Address:
1620 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-4536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-842-8790
Provider Business Practice Location Address Fax Number:
510-842-8789
Provider Enumeration Date:
08/05/2009