Provider First Line Business Practice Location Address:
820 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:
94607-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-567-8109
Provider Business Practice Location Address Fax Number:
510-567-8130
Provider Enumeration Date:
10/31/2012