Provider First Line Business Practice Location Address:
640 61ST 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:
94609-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-914-3221
Provider Business Practice Location Address Fax Number:
510-663-9059
Provider Enumeration Date:
11/02/2006