Provider First Line Business Practice Location Address:
275 14TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-839-9673
Provider Business Practice Location Address Fax Number:
510-839-9674
Provider Enumeration Date:
05/11/2007