Provider First Line Business Practice Location Address:
1708 SHATTUCK AVENUE #2
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:
94709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-841-6058
Provider Business Practice Location Address Fax Number:
510-527-2422
Provider Enumeration Date:
12/28/2006