Provider First Line Business Practice Location Address:
1812 VERDUGO BLVD
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:
91208-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-952-2214
Provider Business Practice Location Address Fax Number:
818-952-4618
Provider Enumeration Date:
07/30/2006