Provider First Line Business Practice Location Address:
3050 EAST 16TH ST.
Provider Second Line Business Practice Location Address:
FRUITVALE DENTAL
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-4700
Provider Business Practice Location Address Fax Number:
510-535-4283
Provider Enumeration Date:
09/06/2006