Provider First Line Business Practice Location Address:
908 S CENTRAL AVE
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:
91204-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-244-6633
Provider Business Practice Location Address Fax Number:
818-244-8543
Provider Enumeration Date:
07/24/2006