Provider First Line Business Practice Location Address:
419 30TH ST STE A
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:
94609-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-8733
Provider Business Practice Location Address Fax Number:
510-444-3668
Provider Enumeration Date:
12/13/2006