Provider First Line Business Practice Location Address:
255 2ND 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:
94607-4307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-433-8340
Provider Business Practice Location Address Fax Number:
510-547-1444
Provider Enumeration Date:
01/29/2012