Provider First Line Business Practice Location Address:
1502 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94709-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-859-4595
Provider Business Practice Location Address Fax Number:
510-280-1629
Provider Enumeration Date:
01/10/2014