Provider First Line Business Practice Location Address:
1928 HUNTINGTON DR STE B
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:
91030-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-799-1252
Provider Business Practice Location Address Fax Number:
626-799-7932
Provider Enumeration Date:
02/06/2008