Provider First Line Business Practice Location Address:
315 ARDEN AVE STE 1
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:
91203-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-287-0300
Provider Business Practice Location Address Fax Number:
858-244-0090
Provider Enumeration Date:
12/09/2025