Provider First Line Business Practice Location Address:
2310 TELEGRAPH 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:
94704-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-5121
Provider Business Practice Location Address Fax Number:
510-848-5350
Provider Enumeration Date:
09/05/2011