Provider First Line Business Practice Location Address:
23 SHORT WAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-448-2113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2024