Provider First Line Business Practice Location Address: 
3838 CALIFORNIA ST
    Provider Second Line Business Practice Location Address: 
316
    Provider Business Practice Location Address City Name: 
SAN FRANCISCO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94118-1522
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
415-379-9600
    Provider Business Practice Location Address Fax Number: 
415-379-9823
    Provider Enumeration Date: 
11/30/2006