Provider First Line Business Practice Location Address:
2187 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:
94704-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-982-3727
Provider Business Practice Location Address Fax Number:
510-982-3737
Provider Enumeration Date:
01/13/2015