Provider First Line Business Practice Location Address:
5463 COLLEGE 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:
94618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-601-6412
Provider Business Practice Location Address Fax Number:
510-601-6412
Provider Enumeration Date:
07/16/2007