Provider First Line Business Practice Location Address:
2081 CENTER 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:
94704-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-705-3656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2010