Provider First Line Business Practice Location Address:
7105 FAVOR ST
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94621-3155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-784-5889
Provider Business Practice Location Address Fax Number:
510-784-9194
Provider Enumeration Date:
11/26/2007