Provider First Line Business Practice Location Address:
2046 LINCOLN ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-949-0945
Provider Business Practice Location Address Fax Number:
510-528-3539
Provider Enumeration Date:
10/02/2006