Provider First Line Business Practice Location Address:
625 FAIR OAKS AVE
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:
91030-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-831-4542
Provider Business Practice Location Address Fax Number:
626-799-4596
Provider Enumeration Date:
03/09/2007