Provider First Line Business Practice Location Address:
1325 MERIDIAN 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:
91030-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-488-8878
Provider Business Practice Location Address Fax Number:
323-222-5960
Provider Enumeration Date:
08/26/2026