Provider First Line Business Practice Location Address:
1305 FRANKLIN STREET
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-528-9865
Provider Business Practice Location Address Fax Number:
510-238-9212
Provider Enumeration Date:
08/01/2006