Provider First Line Business Practice Location Address:
8102 E 14 TH STREET
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:
94621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-633-3044
Provider Business Practice Location Address Fax Number:
510-633-1042
Provider Enumeration Date:
08/31/2011