Provider First Line Business Practice Location Address:
187 40TH STREET WAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-356-7832
Provider Business Practice Location Address Fax Number:
513-350-8552
Provider Enumeration Date:
09/01/2016