Provider First Line Business Practice Location Address:
638 3RD 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:
94607-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3407
Provider Business Practice Location Address Fax Number:
510-238-9764
Provider Enumeration Date:
04/18/2012