Provider First Line Business Practice Location Address:
2232 CARLETON ST
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:
94704-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-297-4068
Provider Business Practice Location Address Fax Number:
510-527-0376
Provider Enumeration Date:
08/16/2007