Provider First Line Business Practice Location Address:
400 34TH 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:
94609-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-6883
Provider Business Practice Location Address Fax Number:
510-869-6888
Provider Enumeration Date:
02/09/2007