Provider First Line Business Practice Location Address:
5463 COLLEGE 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:
94618-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-356-4311
Provider Business Practice Location Address Fax Number:
510-705-1088
Provider Enumeration Date:
03/10/2011