Provider First Line Business Practice Location Address:
5802 COLLEGE 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:
94618-1603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-653-4242
Provider Business Practice Location Address Fax Number:
510-653-4275
Provider Enumeration Date:
06/05/2013