Provider First Line Business Practice Location Address:
1958 A UNIVERSITY AVENUE
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:
94704-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-528-0123
Provider Business Practice Location Address Fax Number:
510-527-7247
Provider Enumeration Date:
01/11/2012