Provider First Line Business Practice Location Address:
2300 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-644-2114
Provider Business Practice Location Address Fax Number:
510-644-2154
Provider Enumeration Date:
07/30/2009