Provider First Line Business Practice Location Address:
3030 ASHBY AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-224-4221
Provider Business Practice Location Address Fax Number:
510-422-1442
Provider Enumeration Date:
10/31/2007