Provider First Line Business Practice Location Address:
741 ADDISON ST
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:
94710-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-647-3825
Provider Business Practice Location Address Fax Number:
510-647-3822
Provider Enumeration Date:
04/04/2007