Provider First Line Business Practice Location Address:
3824 GRAND AVE.
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:
94610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-594-4008
Provider Business Practice Location Address Fax Number:
510-727-9405
Provider Enumeration Date:
02/08/2007