Provider First Line Business Practice Location Address:
1517 ADDISON 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:
94703-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-644-3038
Provider Business Practice Location Address Fax Number:
510-898-0934
Provider Enumeration Date:
05/17/2007