Provider First Line Business Practice Location Address:
6123 LA SALLE 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:
94611-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-339-9393
Provider Business Practice Location Address Fax Number:
510-339-9394
Provider Enumeration Date:
02/02/2007