Provider First Line Business Practice Location Address:
4016 PIEDMONT 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:
94611-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-3830
Provider Business Practice Location Address Fax Number:
510-658-6701
Provider Enumeration Date:
06/21/2006