Provider First Line Business Practice Location Address:
501 E HARVARD 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:
91205-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-621-9586
Provider Business Practice Location Address Fax Number:
818-244-7700
Provider Enumeration Date:
03/12/2007