Provider First Line Business Practice Location Address:
1342 E 27TH ST
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:
94606-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-0611
Provider Business Practice Location Address Fax Number:
510-535-1658
Provider Enumeration Date:
07/06/2016