Provider First Line Business Practice Location Address:
3956 EDGEMOOR PL
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:
94605-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-594-4332
Provider Business Practice Location Address Fax Number:
510-878-7369
Provider Enumeration Date:
03/27/2009