Provider First Line Business Practice Location Address:
638 WEBSTER ST.
Provider Second Line Business Practice Location Address:
SUITE 328
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-268-9888
Provider Business Practice Location Address Fax Number:
510-268-9892
Provider Enumeration Date:
11/29/2006