Provider First Line Business Practice Location Address:
2111 8TH ST UPPR
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:
94710-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-859-8775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2014