Provider First Line Business Practice Location Address:
1931 CENTER 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:
94704-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-666-9552
Provider Business Practice Location Address Fax Number:
510-666-0987
Provider Enumeration Date:
11/14/2018