Provider First Line Business Practice Location Address:
2222 HAROLD WAY STE CW506
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:
94704-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-883-0619
Provider Business Practice Location Address Fax Number:
866-292-1925
Provider Enumeration Date:
12/19/2006