Provider First Line Business Practice Location Address:
680 SPRUCE 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:
94707-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-896-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2017