Provider First Line Business Practice Location Address:
520 16TH STREET
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:
94612-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-6834
Provider Business Practice Location Address Fax Number:
510-268-1599
Provider Enumeration Date:
04/10/2007