Provider First Line Business Practice Location Address:
1416 EL CENTRO ST STE 100
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:
91030-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-399-0649
Provider Business Practice Location Address Fax Number:
866-791-3385
Provider Enumeration Date:
10/17/2006