Provider First Line Business Practice Location Address:
2844 SUMMIT ST
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-893-4183
Provider Business Practice Location Address Fax Number:
510-893-4184
Provider Enumeration Date:
10/12/2005