Provider First Line Business Practice Location Address:
4212 N 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91110-0698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-263-1511
Provider Business Practice Location Address Fax Number:
602-263-1619
Provider Enumeration Date:
11/22/2006