Provider First Line Business Practice Location Address:
149 PASADENA AVE 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:
91030-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-274-3065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2008