Provider First Line Business Practice Location Address:
1900 WEBSTER ST STE A
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:
94612-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-839-4886
Provider Business Practice Location Address Fax Number:
510-834-4323
Provider Enumeration Date:
12/27/2006