Provider First Line Business Practice Location Address:
2397 SHATTUCK AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-599-9421
Provider Business Practice Location Address Fax Number:
949-656-7728
Provider Enumeration Date:
02/28/2008