Provider First Line Business Practice Location Address:
1137 HUNTINGTON DR
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-0123
Provider Business Practice Location Address Fax Number:
323-344-0132
Provider Enumeration Date:
04/25/2007