Provider First Line Business Practice Location Address:
242 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:
91206-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-484-8939
Provider Business Practice Location Address Fax Number:
818-649-1207
Provider Enumeration Date:
02/19/2007