Provider First Line Business Practice Location Address:
815 E. COLODRADO ST.
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-7997
Provider Business Practice Location Address Fax Number:
818-242-7896
Provider Enumeration Date:
07/27/2006