Provider First Line Business Practice Location Address:
3219 ADELINE 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:
94703-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-589-5989
Provider Business Practice Location Address Fax Number:
510-969-4705
Provider Enumeration Date:
10/19/2011