Provider First Line Business Practice Location Address:
4016 PIEDMONT 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:
94611-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-7121
Provider Business Practice Location Address Fax Number:
510-835-0164
Provider Enumeration Date:
05/12/2006