Provider First Line Business Practice Location Address:
2939 ELLIS 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:
94703-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-981-5175
Provider Business Practice Location Address Fax Number:
510-981-5260
Provider Enumeration Date:
11/06/2007