Provider First Line Business Practice Location Address:
424 28TH 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:
94609-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-452-4824
Provider Business Practice Location Address Fax Number:
510-465-4503
Provider Enumeration Date:
04/23/2010