Provider First Line Business Practice Location Address:
238 FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
APT J
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-240-4842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007