Provider First Line Business Practice Location Address:
2116 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-899-4100
Provider Business Practice Location Address Fax Number:
510-350-3322
Provider Enumeration Date:
12/06/2013