Provider First Line Business Practice Location Address: 
2940 SUMMIT ST STE 2D
    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: 
94609-3416
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
510-982-1000
    Provider Business Practice Location Address Fax Number: 
510-210-9310
    Provider Enumeration Date: 
08/08/2017