Provider First Line Business Practice Location Address:
3623 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94619-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-0979
Provider Business Practice Location Address Fax Number:
240-536-7556
Provider Enumeration Date:
12/11/2006