Provider First Line Business Practice Location Address:
17 GLEN EDEN AVE.
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:
94611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-482-9889
Provider Business Practice Location Address Fax Number:
510-749-9136
Provider Enumeration Date:
10/04/2006