Provider First Line Business Practice Location Address:
1422 S GLENDALE AVE
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:
91205-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-242-5554
Provider Business Practice Location Address Fax Number:
818-242-5553
Provider Enumeration Date:
01/25/2008