Provider First Line Business Practice Location Address:
330 ARDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-502-9530
Provider Business Practice Location Address Fax Number:
818-502-9174
Provider Enumeration Date:
07/25/2007