Provider First Line Business Practice Location Address:
1914 LOS ANGELES 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:
94707-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-529-5653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2023