Provider First Line Business Practice Location Address:
1151 EL CENTRO ST STE A
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:
91030-5754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-482-1598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2025