Provider First Line Business Practice Location Address:
3709 E 12TH 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:
94601-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-879-3140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2012