Provider First Line Business Practice Location Address:
6239 COLLEGE 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:
94618-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-473-2533
Provider Business Practice Location Address Fax Number:
718-293-3980
Provider Enumeration Date:
08/29/2013