Provider First Line Business Practice Location Address:
1757 ALCATRAZ AVE
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:
94703-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-350-8742
Provider Business Practice Location Address Fax Number:
510-350-8781
Provider Enumeration Date:
01/10/2011