Provider First Line Business Practice Location Address:
717 E 18TH ST
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:
94606-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-219-1235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2025