Provider First Line Business Practice Location Address:
995 POTRERO AVE
Provider Second Line Business Practice Location Address:
SFGH/CASARC WARD 82
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-6271
Provider Business Practice Location Address Fax Number:
416-206-6273
Provider Enumeration Date:
01/24/2007