Provider First Line Business Practice Location Address:
3451 EAST 12TH STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-3319
Provider Business Practice Location Address Fax Number:
510-535-4187
Provider Enumeration Date:
05/05/2009