Provider First Line Business Practice Location Address:
1400 SHATTUCK AVE STE 1
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:
94709-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-457-8886
Provider Business Practice Location Address Fax Number:
510-705-8520
Provider Enumeration Date:
01/25/2007