Provider First Line Business Practice Location Address:
1454 LEIMERT BLVD
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:
94602-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-3328
Provider Business Practice Location Address Fax Number:
510-530-2566
Provider Enumeration Date:
03/07/2007