Provider First Line Business Practice Location Address:
1207 N HOWARD 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:
91207-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-395-3033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2024