Provider First Line Business Practice Location Address:
2011 ALPHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-500-4637
Provider Business Practice Location Address Fax Number:
323-256-7086
Provider Enumeration Date:
05/06/2009