Provider First Line Business Practice Location Address:
1385 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-841-4668
Provider Business Practice Location Address Fax Number:
510-843-0202
Provider Enumeration Date:
11/06/2010