Provider First Line Business Practice Location Address:
#225 SPRUCE AVE. COR. GRAND AVE.
Provider Second Line Business Practice Location Address:
2ND FLOOR GRAND SPRUCE MEDICAL/DENTAL BUILDING
Provider Business Practice Location Address City Name:
SOUTH SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-588-1237
Provider Business Practice Location Address Fax Number:
650-588-2243
Provider Enumeration Date:
07/08/2006