Provider First Line Business Practice Location Address:
2425 CHANNING WAY
Provider Second Line Business Practice Location Address:
STE. 326
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-407-6414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008