Provider First Line Business Practice Location Address:
1119 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91104-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-422-4162
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2009