Provider First Line Business Practice Location Address:
401 29TH ST
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-835-3680
Provider Business Practice Location Address Fax Number:
510-835-0738
Provider Enumeration Date:
10/05/2006