Provider First Line Business Practice Location Address:
5478A 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-597-1781
Provider Business Practice Location Address Fax Number:
510-658-6011
Provider Enumeration Date:
09/01/2006