Provider First Line Business Practice Location Address:
4173 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94619-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-488-1184
Provider Business Practice Location Address Fax Number:
510-575-6879
Provider Enumeration Date:
11/23/2007