Provider First Line Business Practice Location Address:
495 ELWOOD AVE
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-8494
Provider Business Practice Location Address Fax Number:
510-444-7235
Provider Enumeration Date:
08/21/2006