Provider First Line Business Practice Location Address:
1200 E CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
UNIT H
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91206-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-547-9564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2008