Provider First Line Business Practice Location Address:
1928 SHATTUCK AVE
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:
94704-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-843-4030
Provider Business Practice Location Address Fax Number:
510-843-0151
Provider Enumeration Date:
02/27/2007