Provider First Line Business Practice Location Address:
212 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-7982
Provider Business Practice Location Address Fax Number:
510-465-3876
Provider Enumeration Date:
04/04/2007