Provider First Line Business Practice Location Address:
119 W CALIFORNIA 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:
91203-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-8838
Provider Business Practice Location Address Fax Number:
818-242-8837
Provider Enumeration Date:
03/15/2007