Provider First Line Business Practice Location Address:
546 9TH 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:
94607-3938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-7333
Provider Business Practice Location Address Fax Number:
510-272-4752
Provider Enumeration Date:
05/17/2007