Provider First Line Business Practice Location Address:
327 ARDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-745-4653
Provider Business Practice Location Address Fax Number:
818-502-2630
Provider Enumeration Date:
10/20/2009