Provider First Line Business Practice Location Address:
17 GLENEDEN AVENUE SO
Provider Second Line Business Practice Location Address:
SUITE ONE
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-433-7132
Provider Business Practice Location Address Fax Number:
810-428-9042
Provider Enumeration Date:
10/16/2006