Provider First Line Business Practice Location Address:
2339 DURANT 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:
94704-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-548-2570
Provider Business Practice Location Address Fax Number:
510-548-1730
Provider Enumeration Date:
08/25/2007