Provider First Line Business Practice Location Address:
5835 COLLEGE AVE
Provider Second Line Business Practice Location Address:
#D
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94618-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-653-1464
Provider Business Practice Location Address Fax Number:
510-547-0174
Provider Enumeration Date:
11/18/2005