Provider First Line Business Practice Location Address:
1715 SOLANO AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94707-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-703-6348
Provider Business Practice Location Address Fax Number:
510-848-6274
Provider Enumeration Date:
01/25/2007