Provider First Line Business Practice Location Address:
3550 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:
94602-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-517-2358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2010