Provider First Line Business Practice Location Address:
213 N ORANGE ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-7700
Provider Business Practice Location Address Fax Number:
818-241-7707
Provider Enumeration Date:
12/04/2006