Provider First Line Business Practice Location Address:
287 17TH ST STE A
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:
94612-4191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-990-1484
Provider Business Practice Location Address Fax Number:
510-281-7529
Provider Enumeration Date:
01/23/2007