Provider First Line Business Practice Location Address:
486 49TH ST # C
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:
94609-2178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-394-2203
Provider Business Practice Location Address Fax Number:
510-740-4474
Provider Enumeration Date:
04/27/2020