Provider First Line Business Practice Location Address:
430 S CENTRAL AVE
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:
91204-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6598
Provider Business Practice Location Address Fax Number:
818-241-6599
Provider Enumeration Date:
04/23/2007