Provider First Line Business Practice Location Address:
4141 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:
94602-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-530-3648
Provider Business Practice Location Address Fax Number:
510-530-3648
Provider Enumeration Date:
01/12/2007