Provider First Line Business Practice Location Address:
2607 ALCATRAZ 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:
94705-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-527-7929
Provider Business Practice Location Address Fax Number:
510-903-9595
Provider Enumeration Date:
12/23/2006