Provider First Line Business Practice Location Address:
1926 - 19TH AVENUE
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:
94606-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-879-2953
Provider Business Practice Location Address Fax Number:
510-879-2956
Provider Enumeration Date:
08/05/2009