Provider First Line Business Practice Location Address:
2140 SHATTUCK AVENUE
Provider Second Line Business Practice Location Address:
SUITE 711
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-982-6162
Provider Business Practice Location Address Fax Number:
415-484-7813
Provider Enumeration Date:
11/21/2006