Provider First Line Business Practice Location Address:
3792 HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-5087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-409-7691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2013