Provider First Line Business Practice Location Address:
3145 HIGH 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:
94619-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-533-9970
Provider Business Practice Location Address Fax Number:
510-398-7264
Provider Enumeration Date:
10/03/2016