Provider First Line Business Practice Location Address:
3320 FRUITVALE 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:
94602-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-3156
Provider Business Practice Location Address Fax Number:
510-530-1082
Provider Enumeration Date:
06/13/2006