Provider First Line Business Practice Location Address:
2401 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91001-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-204-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2026