Provider First Line Business Practice Location Address:
1422 HARRISON 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:
94612-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-809-1780
Provider Business Practice Location Address Fax Number:
510-893-1642
Provider Enumeration Date:
09/10/2009