Provider First Line Business Practice Location Address:
1947 CENTER ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-981-7684
Provider Business Practice Location Address Fax Number:
510-981-5345
Provider Enumeration Date:
11/28/2007