Provider First Line Business Practice Location Address:
1307 UNIVERSITY 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:
94702-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-426-3450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2014