Provider First Line Business Practice Location Address:
380 W PORTAL AVE STE E
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:
94127-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-753-1110
Provider Business Practice Location Address Fax Number:
415-753-1123
Provider Enumeration Date:
12/22/2006