Provider First Line Business Practice Location Address:
2140 SHATTUCK AVE.
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-2497
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2006