Provider First Line Business Practice Location Address:
1801 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-225-1025
Provider Business Practice Location Address Fax Number:
510-225-1019
Provider Enumeration Date:
10/19/2006