Provider First Line Business Practice Location Address:
1500 1/2 E HARVARD ST
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:
91205-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-231-9989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2008