Provider First Line Business Practice Location Address:
4547 SAN CARLOS 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:
94601-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-479-0905
Provider Business Practice Location Address Fax Number:
888-806-9078
Provider Enumeration Date:
12/19/2011