Provider First Line Business Practice Location Address:
2484SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BERKELY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-704-7480
Provider Business Practice Location Address Fax Number:
510-704-7494
Provider Enumeration Date:
09/12/2006