Provider First Line Business Practice Location Address:
3318 ELM ST
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:
94609-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-654-9222
Provider Business Practice Location Address Fax Number:
510-654-2349
Provider Enumeration Date:
07/30/2012