Provider First Line Business Practice Location Address:
315 ARDEN AVE
Provider Second Line Business Practice Location Address:
STE 24
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-243-5300
Provider Business Practice Location Address Fax Number:
818-243-5301
Provider Enumeration Date:
05/14/2009