Provider First Line Business Practice Location Address:
1451 28TH 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:
94601-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-239-9830
Provider Business Practice Location Address Fax Number:
510-533-5630
Provider Enumeration Date:
06/29/2026