Provider First Line Business Practice Location Address:
1151 EL CENTRO ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-635-3879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2008