Provider First Line Business Practice Location Address:
2040 VINE ST
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:
94709-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-849-5455
Provider Business Practice Location Address Fax Number:
510-848-9402
Provider Enumeration Date:
08/30/2006