Provider First Line Business Practice Location Address:
2520 CHANNING WAY
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:
94720-5141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-480-9247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2023