Provider First Line Business Practice Location Address:
1521A SHATTUCK AVE STE 201
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:
94709-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-644-0300
Provider Business Practice Location Address Fax Number:
510-845-8530
Provider Enumeration Date:
08/31/2006