Provider First Line Business Practice Location Address:
475 29TH 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:
94609-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-832-3222
Provider Business Practice Location Address Fax Number:
510-222-0442
Provider Enumeration Date:
05/27/2020