Provider First Line Business Practice Location Address:
1000 E PALMER 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:
91205-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-6382
Provider Business Practice Location Address Fax Number:
818-241-8153
Provider Enumeration Date:
02/15/2006