Provider First Line Business Practice Location Address:
1136 FREMONT AVE
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-5757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-441-6563
Provider Business Practice Location Address Fax Number:
310-391-0665
Provider Enumeration Date:
10/27/2006