Provider First Line Business Practice Location Address:
1940 FRUITVALE AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-731-6976
Provider Business Practice Location Address Fax Number:
510-698-8744
Provider Enumeration Date:
10/24/2012