Provider First Line Business Practice Location Address:
193 E ORANGE GROVE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91103-3487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-808-1792
Provider Business Practice Location Address Fax Number:
213-680-9427
Provider Enumeration Date:
07/14/2026