Provider First Line Business Practice Location Address:
1220 MARIPOSA 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:
91205-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-9000
Provider Business Practice Location Address Fax Number:
818-242-3972
Provider Enumeration Date:
12/07/2007