Provider First Line Business Practice Location Address:
380 W PORTAL AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94127-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-285-3895
Provider Business Practice Location Address Fax Number:
410-392-8622
Provider Enumeration Date:
12/05/2006