Provider First Line Business Practice Location Address:
3030 ASHBY AVE
Provider Second Line Business Practice Location Address:
STE. 111A
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-655-3289
Provider Business Practice Location Address Fax Number:
510-658-4914
Provider Enumeration Date:
04/06/2007