Provider First Line Business Practice Location Address: 
2282 UNION ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SAN FRANCISCO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94123-3902
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
415-923-0481
    Provider Business Practice Location Address Fax Number: 
707-778-8697
    Provider Enumeration Date: 
02/08/2007