Provider First Line Business Practice Location Address:
1624 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 1206
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-5555
Provider Business Practice Location Address Fax Number:
510-836-8799
Provider Enumeration Date:
02/12/2014