Provider First Line Business Practice Location Address:
1450 FRUITVALE AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR SUITE E
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-6200
Provider Business Practice Location Address Fax Number:
415-431-3178
Provider Enumeration Date:
01/24/2012