Provider First Line Business Practice Location Address:
2417 CARLETON 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:
94704-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-845-6060
Provider Business Practice Location Address Fax Number:
510-845-5489
Provider Enumeration Date:
10/23/2006