Provider First Line Business Practice Location Address:
1831 SOLANO AVE STE A
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:
94707-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-525-6500
Provider Business Practice Location Address Fax Number:
510-525-6502
Provider Enumeration Date:
12/21/2011