Provider First Line Business Practice Location Address:
3725 COOLIDGE 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:
94602-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-923-0520
Provider Business Practice Location Address Fax Number:
510-653-0433
Provider Enumeration Date:
01/02/2007