Provider First Line Business Practice Location Address:
2118 VINE ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-548-3947
Provider Business Practice Location Address Fax Number:
510-548-3501
Provider Enumeration Date:
01/07/2010