Provider First Line Business Practice Location Address:
1605 JEFFERSON ST
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:
94612-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-973-9651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2020