Provider First Line Business Practice Location Address:
3550 FRUITVALE 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:
94602-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-336-9305
Provider Business Practice Location Address Fax Number:
510-336-9325
Provider Enumeration Date:
01/27/2017