Provider First Line Business Practice Location Address: 
275 W MACARTHUR BLVD
    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: 
94611-5641
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
510-752-1000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/06/2023