Provider First Line Business Practice Location Address:
1525 SHATTUCK AVE STE B
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:
94709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-433-7273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006