Provider First Line Business Practice Location Address:
4547 PARK BLVD
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:
94602-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-6747
Provider Business Practice Location Address Fax Number:
510-530-7018
Provider Enumeration Date:
12/04/2006