Provider First Line Business Practice Location Address:
2100 LAKESHORE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94606-1187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-763-7992
Provider Business Practice Location Address Fax Number:
510-655-3379
Provider Enumeration Date:
02/27/2007