Provider First Line Business Practice Location Address:
5833 COLLEGE 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:
94618-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-658-2020
Provider Business Practice Location Address Fax Number:
510-658-2121
Provider Enumeration Date:
03/16/2007