Provider First Line Business Practice Location Address:
426 17TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-272-0979
Provider Business Practice Location Address Fax Number:
510-272-9303
Provider Enumeration Date:
08/11/2015