Provider First Line Business Practice Location Address:
2612 ALCATRAZ AVE STE 5
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:
94705-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-655-1511
Provider Business Practice Location Address Fax Number:
510-338-6384
Provider Enumeration Date:
01/09/2007