Provider First Line Business Practice Location Address:
1501 FRUITVALE AVE
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:
94601-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-6200
Provider Business Practice Location Address Fax Number:
510-535-4167
Provider Enumeration Date:
02/10/2006