Provider First Line Business Practice Location Address:
373 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-6514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-465-3588
Provider Business Practice Location Address Fax Number:
510-465-4369
Provider Enumeration Date:
07/23/2006