Provider First Line Business Practice Location Address:
725 POTTER 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:
94710-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-982-4200
Provider Business Practice Location Address Fax Number:
510-982-4203
Provider Enumeration Date:
11/16/2007