Provider First Line Business Practice Location Address:
3945 HARRISON ST
Provider Second Line Business Practice Location Address:
APT. 31
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-4576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-0935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006