Provider First Line Business Practice Location Address:
2012 PRINCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94703-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-843-8568
Provider Business Practice Location Address Fax Number:
510-843-4448
Provider Enumeration Date:
03/29/2007