Provider First Line Business Practice Location Address:
1715 SOLANO AVE STE B
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:
94707-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-287-5619
Provider Business Practice Location Address Fax Number:
510-524-3120
Provider Enumeration Date:
08/30/2006