Provider First Line Business Practice Location Address:
1411 E 31ST ST
Provider Second Line Business Practice Location Address:
C/O AUANJA THOMPSON, DEPARTMENT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94602-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-998-0024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2012