Provider First Line Business Practice Location Address:
384 14TH ST
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:
94612-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-532-1930
Provider Business Practice Location Address Fax Number:
510-532-0963
Provider Enumeration Date:
10/20/2012