Provider First Line Business Practice Location Address:
2917 COLLEGE 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:
94705-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-644-3668
Provider Business Practice Location Address Fax Number:
510-644-0418
Provider Enumeration Date:
09/20/2006