Provider First Line Business Practice Location Address:
5020 PROCTOR AVE
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:
94618-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-658-9817
Provider Business Practice Location Address Fax Number:
510-658-9817
Provider Enumeration Date:
06/27/2007