Provider First Line Business Practice Location Address:
2305 ASHBY 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:
94705-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-3372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006