Provider First Line Business Practice Location Address:
1504 ALCATRAZ AVE
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:
94703-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-653-6424
Provider Business Practice Location Address Fax Number:
510-653-1282
Provider Enumeration Date:
12/12/2006