Provider First Line Business Practice Location Address:
2150 SHATTUCK AVE PH WELLNITE
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:
94704-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-952-9555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2021