Provider First Line Business Practice Location Address:
1127 WEBSTER ST STE 4
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:
94607-6531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-625-1136
Provider Business Practice Location Address Fax Number:
510-625-1136
Provider Enumeration Date:
12/13/2006