Provider First Line Business Practice Location Address:
2911 SHATTUCK 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:
94705-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-549-8727
Provider Business Practice Location Address Fax Number:
510-540-1210
Provider Enumeration Date:
06/21/2005