Provider First Line Business Practice Location Address:
1260 B 45TH STREET
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:
94608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-519-1496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2012