Provider First Line Business Practice Location Address:
1624 FRANKLIN ST
Provider Second Line Business Practice Location Address:
STE 910
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-836-4811
Provider Business Practice Location Address Fax Number:
510-836-2338
Provider Enumeration Date:
06/30/2005