Provider First Line Business Practice Location Address:
215 S GRANADA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALHAMBRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91801-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-380-7490
Provider Business Practice Location Address Fax Number:
626-289-3123
Provider Enumeration Date:
03/03/2008