Provider First Line Business Practice Location Address:
4283 PIEDMONT AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-4758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-655-1966
Provider Business Practice Location Address Fax Number:
510-595-4340
Provider Enumeration Date:
05/01/2006