Provider First Line Business Practice Location Address:
1421 INDIANA AVE
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:
91030-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-0661
Provider Business Practice Location Address Fax Number:
323-344-0555
Provider Enumeration Date:
01/22/2007