Provider First Line Business Practice Location Address:
2744 E 11TH 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:
94601-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-621-9131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007