Provider First Line Business Practice Location Address:
1719 LAS PALMITAS ST
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:
91030-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-283-9877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2015