Provider First Line Business Practice Location Address:
2484 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
STE. 210
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-704-7475
Provider Business Practice Location Address Fax Number:
510-704-7494
Provider Enumeration Date:
01/30/2008