Provider First Line Business Practice Location Address:
417 ARDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 112D
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-257-0111
Provider Business Practice Location Address Fax Number:
818-556-3777
Provider Enumeration Date:
08/12/2011