Provider First Line Business Practice Location Address: 
2711 ALCATRAZ AVE STE 5
    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: 
94705-2726
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
510-214-3518
    Provider Business Practice Location Address Fax Number: 
510-296-7778
    Provider Enumeration Date: 
06/11/2011