Provider First Line Business Practice Location Address:
2118 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:
94704-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-841-0681
Provider Business Practice Location Address Fax Number:
510-841-0695
Provider Enumeration Date:
06/08/2007