Provider First Line Business Practice Location Address:
505 PARNASSUS AVE
Provider Second Line Business Practice Location Address:
BOX 0110, UC SAN FRANCISCO M691
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-476-6245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2010