Provider First Line Business Practice Location Address:
3451 E. 12TH ST.
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-3302
Provider Business Practice Location Address Fax Number:
510-536-9453
Provider Enumeration Date:
09/23/2009