Provider First Line Business Practice Location Address:
222W. EULALIA ST.
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-5940
Provider Business Practice Location Address Fax Number:
213-483-9084
Provider Enumeration Date:
05/03/2007