Provider First Line Business Practice Location Address:
510 17TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-433-1150
Provider Business Practice Location Address Fax Number:
510-533-1099
Provider Enumeration Date:
07/24/2014