Provider First Line Business Practice Location Address:
132 N MARYLAND 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:
91206-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-551-1932
Provider Business Practice Location Address Fax Number:
818-551-1936
Provider Enumeration Date:
06/15/2005