Provider First Line Business Practice Location Address:
1111 S CENTRAL 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:
91204-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-244-3800
Provider Business Practice Location Address Fax Number:
818-247-3912
Provider Enumeration Date:
06/08/2008