Provider First Line Business Practice Location Address: 
1701 DIVISADERO ST FL 3
    Provider Second Line Business Practice Location Address: 
UCSF DERMATOLOGY
    Provider Business Practice Location Address City Name: 
SAN FRANCISCO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
94115-3011
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
415-353-7800
    Provider Business Practice Location Address Fax Number: 
415-353-7870
    Provider Enumeration Date: 
06/09/2011