Provider First Line Business Practice Location Address:
2340 WARD ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-649-0640
Provider Business Practice Location Address Fax Number:
510-549-2125
Provider Enumeration Date:
04/28/2006