Provider First Line Business Practice Location Address:
519 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 530
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-452-4281
Provider Business Practice Location Address Fax Number:
510-452-4281
Provider Enumeration Date:
02/20/2007