Provider First Line Business Practice Location Address:
2380 ELLSWORTH ST STE A
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:
94704-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-926-8552
Provider Business Practice Location Address Fax Number:
510-842-0034
Provider Enumeration Date:
07/30/2007