Provider First Line Business Practice Location Address:
2216 MCGEE 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:
94703-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-1352
Provider Business Practice Location Address Fax Number:
510-323-2361
Provider Enumeration Date:
07/16/2007