Provider First Line Business Practice Location Address:
1411 E 31ST ST
Provider Second Line Business Practice Location Address:
QIC 2212
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94602-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-437-4564
Provider Business Practice Location Address Fax Number:
510-437-4573
Provider Enumeration Date:
03/22/2016