Provider First Line Business Practice Location Address:
250 E 18TH ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94606-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-628-0878
Provider Business Practice Location Address Fax Number:
510-628-0765
Provider Enumeration Date:
04/19/2012