Provider First Line Business Practice Location Address:
1949 HUNTINGTON DR
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:
91030-4989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-799-8855
Provider Business Practice Location Address Fax Number:
626-799-1099
Provider Enumeration Date:
06/17/2006