Provider First Line Business Practice Location Address:
3009 CALIFORNIA 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:
94703-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-908-1997
Provider Business Practice Location Address Fax Number:
510-908-1997
Provider Enumeration Date:
08/28/2026