Provider First Line Business Practice Location Address:
2991 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-2921
Provider Business Practice Location Address Fax Number:
509-753-6121
Provider Enumeration Date:
10/18/2005