Provider First Line Business Practice Location Address:
421 ARDEN AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-637-2673
Provider Business Practice Location Address Fax Number:
818-484-2074
Provider Enumeration Date:
03/03/2010