Provider First Line Business Practice Location Address:
1508 WALNUT ST STE D
Provider Second Line Business Practice Location Address:
WALNUT SQUARE
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-540-5555
Provider Business Practice Location Address Fax Number:
510-548-3999
Provider Enumeration Date:
03/29/2007