Provider First Line Business Practice Location Address:
3026 SHATTUCK 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:
94705-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-548-0915
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2009