Provider First Line Business Practice Location Address:
1450 FRUITVALE AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-2999
Provider Business Practice Location Address Fax Number:
510-535-4128
Provider Enumeration Date:
09/06/2006