Provider First Line Business Practice Location Address:
5478A 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:
94618-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-5201
Provider Business Practice Location Address Fax Number:
510-482-3623
Provider Enumeration Date:
05/03/2006