Provider First Line Business Practice Location Address:
3623 MACARTHUR BLVD
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:
94619-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-9924
Provider Business Practice Location Address Fax Number:
510-530-9964
Provider Enumeration Date:
01/22/2009