Provider First Line Business Practice Location Address:
2029 DURANT AVE
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-859-4776
Provider Business Practice Location Address Fax Number:
510-750-7628
Provider Enumeration Date:
05/29/2007