Provider First Line Business Practice Location Address:
2035 LA FRANCE AVE
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:
91030-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-636-7429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2023