Provider First Line Business Practice Location Address:
1416 35TH 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:
94601-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-479-1313
Provider Business Practice Location Address Fax Number:
510-500-3070
Provider Enumeration Date:
07/10/2006