Provider First Line Business Practice Location Address:
1222 S GLENDALE AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-500-3993
Provider Business Practice Location Address Fax Number:
818-500-3994
Provider Enumeration Date:
09/22/2006