Provider First Line Business Practice Location Address:
1321B JOSEPHINE 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:
94703-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-527-0960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007