Provider First Line Business Practice Location Address: 
300 W HUNTINGTON DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ARCADIA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91007-3402
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
213-249-9388
    Provider Business Practice Location Address Fax Number: 
213-389-7993
    Provider Enumeration Date: 
11/17/2015