Provider First Line Business Practice Location Address:
520 OAKLAND 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:
94611-5429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-601-1540
Provider Business Practice Location Address Fax Number:
510-601-1151
Provider Enumeration Date:
12/23/2006