Provider First Line Business Practice Location Address:
50 PHELAN AVENUE
Provider Second Line Business Practice Location Address:
CCSF SHC 100
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94112-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-239-3110
Provider Business Practice Location Address Fax Number:
415-239-3193
Provider Enumeration Date:
08/29/2012