Provider First Line Business Practice Location Address:
1048 UNIVERSITY 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:
94710-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-548-6684
Provider Business Practice Location Address Fax Number:
510-841-7387
Provider Enumeration Date:
09/16/2013