Provider First Line Business Practice Location Address:
914 N GLENDALE 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:
91206-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-7552
Provider Business Practice Location Address Fax Number:
818-241-0248
Provider Enumeration Date:
07/27/2006