Provider First Line Business Practice Location Address:
1208 VIRGINIA 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:
94702-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-287-9279
Provider Business Practice Location Address Fax Number:
510-527-4958
Provider Enumeration Date:
03/14/2007