Provider First Line Business Practice Location Address:
1000 S FREMONT AVE
Provider Second Line Business Practice Location Address:
EASTERN LOS ANGELES REGIONAL CENTER
Provider Business Practice Location Address City Name:
ALHAMBRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91802-7916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-299-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2005