Provider First Line Business Practice Location Address:
1215 W HUNTINGTON DR
Provider Second Line Business Practice Location Address:
SUITE 1 AND 1
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-6374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-796-5593
Provider Business Practice Location Address Fax Number:
626-796-3483
Provider Enumeration Date:
08/24/2006