Provider First Line Business Practice Location Address:
1640 22ND AVE
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:
94606-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-879-1180
Provider Business Practice Location Address Fax Number:
510-879-1189
Provider Enumeration Date:
01/02/2013