Provider First Line Business Practice Location Address:
4809 PENNSYLVANIA 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:
91214-1944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-249-0880
Provider Business Practice Location Address Fax Number:
818-957-8570
Provider Enumeration Date:
06/19/2007