Provider First Line Business Practice Location Address:
3346 LAKESHORE 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:
94610-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-9771
Provider Business Practice Location Address Fax Number:
510-444-9773
Provider Enumeration Date:
01/30/2007