Provider First Line Business Practice Location Address: 
375 LAGUNA HONDA BLVD
    Provider Second Line Business Practice Location Address: 
LAGUNA HONDA HOSPITAL AND REHAB CENTER, MEDICAL SVCS
    Provider Business Practice Location Address City Name: 
SAN FRANCISCO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94116-1411
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
415-759-2300
    Provider Business Practice Location Address Fax Number: 
415-759-6319
    Provider Enumeration Date: 
02/20/2007