Provider First Line Business Practice Location Address:
1612 38TH AVE
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:
94601-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-561-3688
Provider Business Practice Location Address Fax Number:
510-561-3688
Provider Enumeration Date:
09/25/2026