Provider First Line Business Practice Location Address:
1219 PERALTA 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:
94607-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-880-8138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2025