Provider First Line Business Practice Location Address:
1139 ADDISON ST
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94702-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-495-5752
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2012