Provider First Line Business Practice Location Address:
2905 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:
94705-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-224-8141
Provider Business Practice Location Address Fax Number:
510-848-9970
Provider Enumeration Date:
10/03/2025