Provider First Line Business Practice Location Address:
2479 LE CONTE AVE APT 3
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:
94709-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-464-1441
Provider Business Practice Location Address Fax Number:
510-991-1562
Provider Enumeration Date:
12/02/2009