Provider First Line Business Practice Location Address:
1266 14TH 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:
94607-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-882-7791
Provider Business Practice Location Address Fax Number:
510-531-0258
Provider Enumeration Date:
08/03/2024