Provider First Line Business Practice Location Address:
2607 MYRTLE ST
Provider Second Line Business Practice Location Address:
MCCLYMONDS HIGH SCHOOL
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-238-8607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2014