Provider First Line Business Practice Location Address:
3451. EAST 12TH ST. 2ND FLOOR
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:
94601-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-3319
Provider Business Practice Location Address Fax Number:
510-535-1487
Provider Enumeration Date:
07/29/2010