Provider First Line Business Practice Location Address:
2115 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:
94601-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-393-8559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2017