Provider First Line Business Practice Location Address:
730 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-956-1577
Provider Business Practice Location Address Fax Number:
818-244-5308
Provider Enumeration Date:
10/25/2006