Provider First Line Business Practice Location Address:
1340 E 28TH 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:
94606-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-881-6232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2022