Provider First Line Business Practice Location Address:
1945 W GLEN OAK BL
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:
91201-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-566-1917
Provider Business Practice Location Address Fax Number:
818-566-1921
Provider Enumeration Date:
02/20/2007