Provider First Line Business Practice Location Address:
1211 WARD 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:
94702-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-708-2640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2020