Provider First Line Business Practice Location Address:
1211 BRUNSWICK 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:
91030-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-258-3060
Provider Business Practice Location Address Fax Number:
323-258-1040
Provider Enumeration Date:
06/02/2006