Provider First Line Business Practice Location Address:
3800 LA CRESCENTA AVE.
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LA CRESCENTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91214-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-205-2525
Provider Business Practice Location Address Fax Number:
818-223-8303
Provider Enumeration Date:
01/29/2021