Provider First Line Business Practice Location Address:
1220 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-545-9539
Provider Business Practice Location Address Fax Number:
818-545-0715
Provider Enumeration Date:
03/15/2010