Provider First Line Business Practice Location Address:
2134 MCGEE AVE
Provider Second Line Business Practice Location Address:
APT A
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94703-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-326-0262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2009