Provider First Line Business Practice Location Address:
1317 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:
91030-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-5547
Provider Business Practice Location Address Fax Number:
323-344-5550
Provider Enumeration Date:
03/16/2007