Provider First Line Business Practice Location Address:
2901 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE 'E'
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-649-9663
Provider Business Practice Location Address Fax Number:
510-842-1715
Provider Enumeration Date:
01/12/2014