Provider First Line Business Practice Location Address:
1132 ARCH 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:
94708-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-525-1910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2006