Provider First Line Business Practice Location Address: 
744 52ND ST.
    Provider Second Line Business Practice Location Address: 
AUDIOLOGY CLINIC
    Provider Business Practice Location Address City Name: 
OAKLAND
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94609
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
510-428-3885
    Provider Business Practice Location Address Fax Number: 
510-450-5631
    Provider Enumeration Date: 
01/14/2008