Provider First Line Business Practice Location Address:
1708 SHATTUCK 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:
94709-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-524-9064
Provider Business Practice Location Address Fax Number:
510-527-2422
Provider Enumeration Date:
10/17/2006