Provider First Line Business Practice Location Address:
445 W GARFIELD AVE STE 1
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:
91204-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-721-0001
Provider Business Practice Location Address Fax Number:
323-664-1212
Provider Enumeration Date:
07/03/2008