Provider First Line Business Practice Location Address:
5665 COLLEGE AVE
Provider Second Line Business Practice Location Address:
240B
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94618-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-433-7315
Provider Business Practice Location Address Fax Number:
510-848-8343
Provider Enumeration Date:
07/27/2006