Provider First Line Business Practice Location Address:
3040 E 9TH ST
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-534-0706
Provider Business Practice Location Address Fax Number:
510-534-1082
Provider Enumeration Date:
06/08/2007