Provider First Line Business Practice Location Address:
1533 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
2ND FLR.
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-282-3695
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2017