Provider First Line Business Practice Location Address:
3223 LAKESHORE 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:
94610-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-842-6431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009