Provider First Line Business Practice Location Address:
1134 NORTH BRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-246-2253
Provider Business Practice Location Address Fax Number:
818-246-2892
Provider Enumeration Date:
08/19/2006