Provider First Line Business Practice Location Address:
1209 N. CENTRAL AVE
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-840-3229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2008