Provider First Line Business Practice Location Address:
1443 LEIMERT BLVD
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:
94602-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-482-5300
Provider Business Practice Location Address Fax Number:
510-482-5355
Provider Enumeration Date:
11/29/2018