Provider First Line Business Practice Location Address:
2372 ELLSWORTH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-549-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2007