Provider First Line Business Practice Location Address: 
550 16TH ST FL 4
    Provider Second Line Business Practice Location Address: 
UCSF PEDIATRICS, BOX 0110, ROOM 4551
    Provider Business Practice Location Address City Name: 
SAN FRANCISCO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94158-2549
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
415-476-6245
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/11/2013