Provider First Line Business Practice Location Address:
VA--2505 W. 14TH ST., BLDG. 762
Provider Second Line Business Practice Location Address:
OAKLAND ARMY BASE
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-587-3435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006