Provider First Line Business Practice Location Address:
2576 SHATTUCK AVE STE 3
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:
94704-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-804-1671
Provider Business Practice Location Address Fax Number:
888-733-0664
Provider Enumeration Date:
09/11/2008