Provider First Line Business Practice Location Address:
1220 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
GLANDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-548-8333
Provider Business Practice Location Address Fax Number:
818-548-7888
Provider Enumeration Date:
10/04/2006