Provider First Line Business Practice Location Address:
714 SPRUCE 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:
94707-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-526-4442
Provider Business Practice Location Address Fax Number:
510-527-6842
Provider Enumeration Date:
07/23/2006