Provider First Line Business Practice Location Address:
1605 JEFFERSON 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:
94612-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-526-4765
Provider Business Practice Location Address Fax Number:
510-526-2887
Provider Enumeration Date:
06/14/2021