Provider First Line Business Practice Location Address:
607 27TH 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:
94612-2195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-901-4167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2023