Provider First Line Business Practice Location Address:
1927 NORTH LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALDADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-258-7793
Provider Business Practice Location Address Fax Number:
626-398-8776
Provider Enumeration Date:
11/07/2025