Provider First Line Business Practice Location Address:
208 S LOUISE ST
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:
91205-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-840-9484
Provider Business Practice Location Address Fax Number:
818-840-9485
Provider Enumeration Date:
02/16/2009