Provider First Line Business Practice Location Address:
1947 FRANCISCO 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:
94709-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-655-5582
Provider Business Practice Location Address Fax Number:
510-655-6129
Provider Enumeration Date:
08/01/2006