Provider First Line Business Practice Location Address:
5309 COLLEGE 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:
94618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-985-2958
Provider Business Practice Location Address Fax Number:
510-428-2789
Provider Enumeration Date:
09/28/2007