Provider First Line Business Practice Location Address:
1543 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-4203
Provider Business Practice Location Address Fax Number:
510-848-4203
Provider Enumeration Date:
01/06/2007