Provider First Line Business Practice Location Address:
1409 EDITH ST
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:
94703-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-526-4246
Provider Business Practice Location Address Fax Number:
510-528-7732
Provider Enumeration Date:
04/07/2007